EAST END / VALLEY STREET NEIGHBORHOOD ASSOCIATION Emergency Preparedness Survey

EAST END / VALLEY STREET NEIGHBORHOOD ASSOCIATION

2026 Emergency Preparedness Survey
In order to respond in an emergency, we want to have a better understanding of all of our EEVS neighbors - where we have energy and skills, and where we have needs.

If you have multiple adults in your household who have skills/energy to contribute, please have each person fill out a separate form.

Otherwise, one person can fill out the form for the entrie household. Feel free to add contact information for those who wish to be reachable in an emergency.
Street Address:
Name:
Phone Number:
Format: (000) 000-0000.
Email Address:

Confirmation Emailexample@example.com
Additional Name:
Phone Number:
Format: (000) 000-0000.
Email Address:

Confirmation Emailexample@example.com
Additional Name:
Phone Number:
Format: (000) 000-0000.
Email Address:

Confirmation Emailexample@example.com
Additional Name:
Phone Number:
Format: (000) 000-0000.
Email Address:

Confirmation Emailexample@example.com
To help EEVS quantify water/food to store in case of emergency, please share the number of people in your household:
To help EEVS support you in case of emergency, please share any special needs of people in your household:

What skills/services could you volunteer to our neighborhood in an emergency?
Please describe what skills/services could you volunteer to our neighborhood in an emergency?
Medical (for example: Doctor/Nurse, First Aid or CPR Trained)
Skilled Emergency Response (for example: Search & Rescue, Firefighter/EMT)
Mental Health (for example: Crisis Counselor)
Communications (for example: HAMM Radio Operator)
Repair (for example: Construction, Electrician, Plumber)
Specialized Support (for example: Child Care, Elder Care, Pet Care, Language Translation)

Please share any additional information you would like for us to know.
Privacy Notice: This information will be kept confidentially within the EEVS neighborhood. However, in the event of a disaster, it may be shared with official Emergency Responders entrusted to provide us aid.
East End/Valley Street Neighborhood Association • EastEndValleyStreet.org •
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